| NPI | 1346506201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA A153454) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 9172) |
| 208600000X Surgery (Licence: CA A153454) | |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2018-06-29 |